HEALTH CARE DELIVERY IN INDIA

HEALTH CARE SYSTEMS

In India, it represented by five major sectors or agencies 

which differ from each other by the health technology 

applied and by the source of funds for operation.

1. PUBLIC HEALTH SECTOR

(a) Primary health carePrimary health centerssub‐centers

(b) Hospitals/Health centersCommunity health centersRural hospitalsDistrict hospital/health centerSpecialist hospitalsTeaching hospitals

(c) Health Insurances schemesEmployees state insuranceCentral Govt. Health Scheme

(d) Other agenciesDefence servicesRailways 

2. Private Sector 

(a) Private Hospitals, polyclinics, Nursing homes and  

Dispensaries.

(b) General practitioners and clinics

3. Indigenous system of Medicine

Ayurveda, Siddi, Unani and Tibbi, Homeopathy

4. Voluntary Health Agencies 

5.National Health Programmes

Primary Health Care in India

1. Village Level

One of the basic tenets of this is universal coverage and equitable distribution of health resources. 

a. Village Health Guides

b. Training of Local Dais

c. ICDS scheme (Anganwadi Workers)

2. Sub centre level

3.Primary health centre level

COMMUNITY HEALTH CENTRE (3,276) 80,000-

1,20,000PRIMARY HEALTH

CENTRE (23,730) 30,000

SUB CENTRE (1,38,000)5000

VILLAGE LEVEL

VILLAGEHEALTH GUIDES

LOCALDAIS ANGANWADI

WORKER

Village Health Guides

A village health guide is a person with an aptitude for

social service and is not a full time government functionary.

The health guide are now mostly women.

They serve as links between the community and the

governmental infrastructure. They provide the first contact

between the individual and health system.

Guidelines:Be permanent resident of the local community

Have minimum formal education (VI class)

Spare at least 2‐3 hours/day for community health work

After selection ,they undergo training in nearest PHC for 3 months .1 for each village per 1000 rural population

Duties Treatment of simple medical problem and first aid,

Mother and child health care including family planning,

Health education and Sanitation

Local dais

traditional birth attendants‐ concepts of maternal and child health and sterilization, besides obsteric skills. 

The training is for 30 working days. She is paid a stipend of Rs. 300 during her training period. Training is given at the PHC, sub‐center or MCH center for 2 days in a week, and on the remaining four days of the week they accompany the health worker. 

They are expected to play vital role in propagating small family norms

emphasis is given on asepsis so that home deliveries are conducted under safe hygiene to reduce maternal and child mortality.

After successful completion of training, each dai is provided with a

delivery kit and a certificate. She is entitled to receive an amount of Rs.

10 per delivery provided the case is registered with the sub‐center/PHC.

To each infant registered by her, she will receive Rs.3.

Anganwadi worker

Under the ICDS (Integrated Child Development Services) scheme, there is an

anganwadi for a population of 1000. there are about 100 such workers in

each ICDS Project.

training in various aspects of health, nutrition, and child

development for 4 months.

She is a part‐time worker and is paid an honorarium of RS.200‐250

per month for the services rendered, which include health check‐

up, immunization, supplementary nutrition, health education, non‐

formal pre‐school education and referral services.

The beneficiaries are especially nursing mothers, other women (15‐

45years) and children below the age of 6 years.

Sub‐center level

• 1 subcentre ‐ 5000 population in general but in hilly, tribal and backward areas 1 ‐ 3000 population.

• Two functionaries at this level ‐ Health worker male  and  health worker female (multipurpose worker).

• 6‐8 month in service training and orientation by PHCs medical officer.

• Form a link between health guide and PHC and responsible for all health services and programs in that area, work under the supervision of health assistant

Primary health center 

1 PHC for every 30,000 population rural population in plains, 

1 PHC for every  20,000 population in hilly, tribal and backward areas, has been proposed for effective coverage. 

Functions 

1. Education ‐ health problems and the methods of preventing and controlling them.

2. Promotion of food supply and proper nutrition. 

3. An adequate supply of safe water and basic sanitation.

4. Maternal and child health care.

5. Immunization against major infectious diseases.

6. Prevention and control of locally endemic diseases.

7. Appropriate treatment of common diseases and injuries.

8. Provision of essential drugs.9. National Health Programs‐ as relevant 10. Referral services11. Training of health guides, health workers, local dais and health 

assistants.

Staffing pattern  

Medical officer                                      1

Pharmacist                                            1

Nurse mid‐wife                                      1

Health worker                                       1

Block extension educator                       1

Health assistant (male)                          1

Health assistant (female)                       1

Lab technician                                       1

Driver                                                    1

Class IV                                                  4

Community health center 

• One out of 4 PHC’s in community developmental block upgraded and recognized as  Community Health Center (CHC).

• Should have 30 beds with the specialist in surgery, medicine, gynecology and pediatrics with x‐ray and laboratory facilities.

• Covers population of 80,000‐1,20,000.

Health insurance

• No universal health insurance in India

• At present limited to industrial workers and their families

• Central government employees covered by health insurance

Employees state insurance scheme (ESI)

• Introduced in 1948

• Contribution by employer and employee

• Provides for medical care in cash and kind, benefits in the contingency ofsickness, maternity, employment injury and pension for dependents on deathof worker due to employment injury

• Covers salary < 10,000/month

• Covers all employees – manual, clerical, supervisory and technical

Central government health scheme (cghs)

• Introduced in 1954 in NewDelhi

• Covers employees of autonomous organisations, retired central government servants, widows receiving family pension, MP’s, Ex‐Governors and retired judges

• Covers about 42.76 lakh beneficiaries through 320 dispensaries/hospitals 

Other agencies

• Defence medical services– Armed forces medical services

• Health care of railway employees– Railway hospitals and clinics

– Yearly health check ups

Private agencies

• Private hospitals

• Independent clinics

• 70% general practitioners

• Highly unorganized, concentrated in urban areas

• Provide mainly curative services

• MCI, IMA regulate some functions and activities

Indigenous system of medicine

• Provide bulk of medical care to rural people

• National Institute of Ayurveda

• National Institute of Homeopathy

• Govt studying how these can be best utilized for more effective health coverage

Voluntary health agencies in India1. Indian Red Cross Society2. Hind Kusht nivaran sangh3. Indian council for child welfare4. Tuberculosis association of India5. Bharat sevak samaj6. Central social welfare board7. The kasturba memorial fund8. The All‐India blind relief society9. Professional bodies10. International agencies

National health programmes1. Anti‐malaria programme2. National filaria control programme3. Kala‐azar control programme4. Japanese encephalitis control5. Dengue control6. National Leprosy‐eradication programme7. National tuberculosis programme8. National AIDS control programme9. National programme for control of blindness10. Iodine deficiency programme11. Universal immunization programme12. Reproductive and child health programme13. National caner control programme

Targeted areas

• Elements of primary health care

• Referral system 

• Comprehensive health care

• Principles of primary health care

• Primary health care

• National health programmes

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